[TIPSS: 10 years of clinical experience]

To demonstrate and document 10 years of clinical experience gathered by us with TIPSS and to discuss achievements, problems and outlook.

The analysis is based on the following parameters: portosystemic gradient; morphological delineation of the portal circulation; determination of the portal perfusion fraction (PPF) and the total liver perfusion (GLP); arterial flow changes; hepatic encephalopathy; incidence of restenotic shunt occlusion and recurrent variceal bleeding.

Variceal filling was widely reduced by TIPSS, and significantly reduced portal liver perfusion as assessed morphologically and rheologically. However, there was an immediate onset of compensated liver perfusion by increased arterial inflow. Total liver perfusion did not change significantly. In TIPSS portal decompression was readily achieved, the portosystemic gradient dropping from an average of 24 mm Hg to 10.5 mm Hg. In our series we could not demonstrate an increased incidence of hepatic encephalopathy during the 30-day post-TIPSS period. Early mortality was 4% and early rebleeding rate 3%. The 12-month re-intervention rate based on an invasive portography follow-up protocol was 76%, and the 24-month re-intervention rate was 90%. The definite occlusion rate was below 5%. Beyond a follow-up time span of 24-months the necessity for re-intervention dropped significantly: less than one-third of our patients required some sort of re-intervention.

The concept of TIPSS represents an individually calibrated H-shunt. The significant reduction of post-TIPSS portal perfusion appears to be compensated by increased arterial inflow. This is reflected by an invasive flow measurement results and by the clinical results. Lethality of TIPSS is low mostly as a result of a refined technique, careful patient selection, follow-up care and meticulous shunt surveillance.